I’m not thrilled with it, just like everything else I do. There’s more to tell, more to sort through, more to figure out. I want to be able to tell you I am all better, but I’m not there yet.

PPD can disguise itself as normal parenting fears, irresponsibility, anger. It can cause a grown up to behave childishly or irrationally. And moms, of all people, are most likely to want to hide it, and to be capable of doing so. We keep going, because really – we have to.

I can only tell you, if you are reading my story because you have one of your own – get help. Tell someone you are not sure what’s going on, but you might be about to self-destruct. Force yourself to ask for what you need, or arrange someone else to make sure you are getting it. Friends won’t mind lending a hand.

Hello. Welcome back to another exciting episode of, “What to do when you have dropped your basket.”

What is “dropping your basket”? I’m glad you asked.

Often, it is nothing more than being weepy and dysphoric, not enjoying things you once did. It can also manifest as:

1. Irritability

2. Obsessiveness / OCD. OCD can sometimes be just obsessiveness without compulsions, and hand-washing and tidiness are not the only signs. Trust me; I know. Look for fear/concern over toxins, frequent thoughts of the baby being hurt or something being wrong with her, checking things over and over even though you just checked them, even words, phrases, or music repeating themselves in your head. OCD can focus on numbers, textures, certain rhythms.

3. Outbursts of anger, even episodes of violence (including punching walls, throwing things, and kicking holes in the cupboards).

4. Anxiety, memory problems, feelings of emptiness, losing interest in things that you used to find pleasurable

There are surely more. Some would suggest that this cornucopia of symptoms might better be called something else. Postpartum syndrome?

In any event, clearly the usual question of “do you feel sad and not want to get out of bed in the morning” doesn’t really cut it as a diagnostic tool.

But let’s say you already know. Let’s imagine that you’ve struggled with depression throughout your life, so you know you are more at risk for severe PPD, and you kinda know what it looks like.

What do you do?

There are many options available. I would have to say that the top five solutions are all occupied by the words “find support.” Whether this means help at home with children, meals, or housework, or a friend who is a good listener, or a therapist of some kind – do it. Do it all. Don’t keep quiet. Now, that said – I am the quiet sort. No one has any idea just how far down I had sunk. In fact, I think depression feeds on itself and postpartum depression has its own unique brand of vicious cycle. We are mothers. We are supposed to be able to do this thing, right? So when we can’t, we feel awful about ourselves. This feeling awful makes everything worse. When you believe you are an epic FAIL as a parent, why in the world would you want to advertise?

So more than just seeking out help and support for yourself, it’s important that you have the people closest to you understand what to look for. Have them ask you how long it’s been since you showered (but please don’t ask me how long – not today). Schedule someone to come over once a week for a standing date, no matter how little you feel like being social. If that person knows they are there to make sure you are okay, they will be respectful of your limits. Sleep. Exercise. Eat right. You know the drill.

If these things don’t work, then what?

We are lucky to live in a time when medications for depression are so much better than they used to be. SSRIs are excellent medications for dealing with depression, anxiety, anger and OCD. Some are better at handling some things than others, so have this discussion with your physician. And most are safe to varying degrees, particularly Zoloft. For the best resource available on medication use during pregnancy, I recommend Dr. Thomas W. Hale’s book, Medications and Mothers Milk: A Manual of Lactational Pharmacology. Hediscusses many of the medications used for depression and how they can affect your baby and you. The book is often available through a local La Leche League group lending library (LLLLLL??), and there are discussion forums on his website. Be forewarned, however, that consumer questions are not accepted and many of the forums essentially tell you to read the book.

If the first line of antidepressants don’t work for you, what should you do?

If breastfeeding is well established and your baby is a little older, there are more options. But what if you have tried some of the stronger medications, and it looks like your only option is to wean and break out the big guns or continue to struggle? How do you make that choice?

My baby is twenty months old. I nursed my last child to the age of three. I really never expected to do that, but somehow you just get caught up in things. He had emotional and behavioral issues which made parenting him extremely difficult, and breastfeeding was my ace in the hole. I admit it – I’m lazy. I wanted an easy way to get this child to sleep at the end of my grueling days, and nursing was like slipping him a mickey. His eyes would even roll back in his head as he went on the nod. Now my little Beckett is pretty addicted to it, too. And he is my last baby. Once I wean him, I will never share that bond with another one, which is sort of depression-inducing on its own, for me.

So I find myself weighing the seriousness of my depression with my knowledge that I might have to sever the breastfeeding relationship. It’s a sucky place to be. And the worst part of it is, it’s a selfish position. My mental health being stable is so much more of an influence over my almost-two-year-old than a few more months of breastfeeding. But I don’t want to feel I sacrificed that relationship for nothing, since trying a new medication is always a crap shoot.

I began writing this thinking I would have some resolution at the end. And I hate to leave anyone without solving the problem, least of all myself. But no one really knows all that much. In the end, it’s about weighing the pros and cons and making an informed choice, much like anything else having to do with parenting. Seek out people who have been through it. Keep talking and asking questions. Even if it’s too late for us to have real answers, maybe our daughters will.

Tomorrow on Blogher: why I’m such a know-it-all when it comes to depression.

I have turned this topic around and around in my head over the last few days. And now several bloggers have beat me to the punch.

But that’s okay, because I’ve decided to take a slightly different direction with it. I want to talk about medications used to treat depression, anxiety, irritability, anger, and suicidal ideation, and their place during breastfeeding, but not before a little chat about postpartum depression itself.

First, let me tell you what your votes say:

The majority of you (41%) would live with the depression and continue breastfeeding, 24% of you would take a medication with uncertain risk and continue breastfeeding, 17% would seek or increase counseling and continue, about 13% would wean (divided in half at less than 3 months or 6-12 months), and about 3% would do something else entirely, which I am not sure I want to know about. Okay, maybe this is not the best time for my dark sense of humor.

But let me tell you what is going on right at this moment:

I have a diaperless toddler running around who just peed on the floor, a 4 year old riding a Kettler trike around the dining room (where I am) because it’s been raining for 837 days, a pizza burning in the oven because that’s the only thing Ethan will eat at the moment, a blog post I desperately need to write, and a migraine. And all of this on two hours of sleep, because Beckett’s “language explosion” decided to happen today. At two in the morning.

You may find yourself thinking – clearly this woman is not depressed! She is far too funny and lighthearted to be depressed! And clearly she is totally insane. Not depressed at all.

And so here we begin. Some of the posts I’ve been reading on this issue indicate that the symptoms most people associate with depression can be lacking or distorted, leaving many women with confusion over their feelings and no help, since no one realizes they are suffering from depression.

Baby Ready, for instance, talks about the extreme anger she felt, which caused a terrible cycle of being irritable, yelling at kids, yelling at self for yelling at kids, then hating self, which causes more irritability. Joanna at the Modernity Ward writes about obsessing over safety issues, having outbursts of anger, and even punishing herself for perceived failings as a mother.

There are so many problems with diagnosing postpartum depression. The only time a woman really sees her care provider after the birth is at the six week checkup. If a woman has any kind of support network like a church or family close by, she has probably been getting at least a little help up to this point, in the form of meals, or just leave from a regular job. And the symptoms must be present for at least two weeks in order to meet DSM-IV criteria, although there is room for clinician judgment within the diagnostic framework. Postpartum depression typically manifests itself around four weeks after parturition, but can be delayed as long as a full year. And it can last beyond the one year mark. This means that a care provider might never see even the slightest hint of a problem.

When you have a baby, you know you will not get significant sleep for the first few weeks, so you nap when possible. You are encouraged to nap, in fact! People bring you meals, sometimes. You understand that a newborn is a particular kind of challenge so you are somewhat emotionally prepared for it. But then something else happens: the baby gets older. People start asking you if he is sleeping through the night yet (breast milk is more quickly digested than formula, and even formula does not guarantee a “good” sleeper; in fact, some studies show that a lighter sleep is best because the frequent rousings can prevent SIDS). Community members may expect you to start “getting back out there.” There is quite a lot of pressure to participate, to be active and constantly busy, which makes it hard to just be – home, snuggling with your baby, lying around in your pajamas when you feel like it, enjoying your children.

According to the Centre for Addiction and Mental Health (part of the University of Toronto), postpartum depression is the “most common complication of child-bearing,” affecting an average of 13% of women who have given birth. Did you hear that? THE MOST COMMON COMPLICATION OF CHILD-BEARING. Much higher than the rate of being diagnosed with breast cancer (I am aware that the breast cancer rate applies to every woman, and the PPD rate applies only to women who have given birth. For a woman who has given birth, the numbers mean the same. A woman who hasn’t – well, she wouldn’t have PPD, would she?)

I bring up the statistics only because I believe we need to begin having this conversation now. You know the facebook app asking if you’ve felt your titties? If we are comfortable enough to ask that question in that middle-school way, certainly we can ask the hard questions about “How are you doing?” and start to make it acceptable to answer honestly.

I don’t know a mother who doesn’t ever lose her temper. I don’t know a mother who doesn’t think she is screwing up her kids in some permanent way. I don’t know a mother who doesn’t wonder sometimes, in the really bad moments, why she ever had these children anyway. I do know mothers who pretend. And I know mothers who silently punish themselves for what they see as their inability to measure up, because they don’t know what happens in their friends’ homes.

Here are the main issues I see:

1. Women generally have to take care of life, whether they feel like it or not. We are more practiced at keeping our boat afloat because who the hell else is going to do it? Some things may get neglected, but enough might be held together that no one really notices there are problems until the situation has spiralled out of control.

2. The modern world is a scary place. If I say I’m afraid of lead in toys and phthalates in plastic, no one is going to think it’s all that strange because everyone is scared of that. Well, okay – a lot of people. Moms. A bunch of moms. Anyhoo – If you don’t press me, I’m not going to tell you that I lie awake at night imagining the damage the plastics are doing to my babies’ endocrine systems and telling myself what a bad mommy I am because my son played with that plastic toy at the book store today.

3. Women generally do not talk about committing violent acts, no matter how small. Throwing an iron (like Joanna), kicking a hole in the cupboard (um, that one’s mine), or striking a child are all violent acts. We want to model better behavior, but intense anger is a symptom – a symptom of depression! It took me 30 years of therapy for someone to let me in on this little secret.

So now you know what postpartum depression can look like. Tomorrow, we’ll see what medications are available to use while breastfeeding, as well as how we, as members of a community, can help women identify and recover from its most severe symptoms.

And then, when all the facts are delivered, I will tell you a story. My story.

I am asking for some personal information here, so please don’t feel pressure to comment or use any kind of real name. I would, however, greatly appreciate any of your story you feel comfortable sharing.
I think this is a topic that we don’t hear enough about, and the decision to use medication while breastfeeding is a highly polarizing one. I have heard people say that breastfeeding is so important that any potential risk is minimal, and I have also heard it said that no risk is worth taking when it comes to your child’s health.

I thank you ahead of time for sharing your experience, even if simply to answer the poll question. Feel free to explain or add whatever you wish in the comments section. I hope to see some lively discussion, and I will get back to you with the results and some research, as well.

I would like to thank PhDinParenting for answering my plea for help in developing this poll – she came through in spades, as she always does for her own readers.